Rheumatology Research Articles

205. The UK Primary Sjögren’s Syndrome Registry (UKPSSR): A Valuable Resource for Future Sjögren’s Syndrom Research

Katherine James, Dennis Lendrem, Sheryl Mitchell, Victoria Hindmarsh, Simon Bowman, Elizabeth J. Price, Colin T. Pease, Paul Emery, Peter Lanyon, John Hunter, Monica Gupta, Michele Bombardieri, Nurhan Sutcliffe, Costantino Pitzalis, John McLaren, Annie Cooper, Marian Regan, Ian P. Giles, David A. Isenberg, Saravanan Vadivelu, David Coady, Bhaskar Dasgupta, Neil McHugh, Bridget Griffiths and Wan-Fai Ng Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, School of Computing Science, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne Hospitals NHS Foundation Trust, RVI and Freeman, Newcastle upon Tyne, University Hospital Birmingham, Birmingham University, Birmingham, Great Western Hospitals NHS Foundation Trust, Great Western Hospital, Swindon, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, Leeds Teaching Hospitals Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, Nottingham University Hospital, Department of Clinical Immunology, Nottingham, Gartnavel General Hospital, Department of Rheumatology, Glasgow, Barts and the London NHS Trust, Department of Rheumatology, London, Barts and the London School of Medicine and Dentistry, Department of Rheumatology, London, Whyteman’s Brae Hospital, NHS Fife, Kirkcaldy, Royal Hampshire Country Hospital, Department of Rheumatology, Winchester, Royal Derby Hospital, Department of Rheumatology, Derby, University College London Hospitals NHS Foundation Trust, University College Hospital, London, Queen Elizabeth Hospital, Department of Rheumatology, Gateshead, Sunderland Royal Hospital, Department of Rheumatology, Sunderland, Southend University Hospital, Department of Rheumatology, Southend, Royal National Hospital for Rheumatic Diseases, Department of Rheumatology, Bath, UK

Statistics, damn statistics and rheumatology

Statistics, damn statistics and rheumatology

Introduction of diagnosis and treatment of lupus nephritis

Following great progress on the pathogenesis of lupus nephritis (LN) and publication of many high quality (prospective, randomized, multicenter) clinical trials of glucocorticoids-plus-immunosuppressive interventions, the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), and Kidney Disease: Improving Global Outcomes (KDIGO) published or renewed in succession in 2012 special guidelines or recommendations for screening, case definition, treatment and management of LN.The paper introduces the key contents to provide reference for the clinical practice. Key words: Lupus nephritis; Guideline; Recommendation

Effects of allicin on apoptosis of human rheumatoid arthritis fibroblast-like synoviocytes

Objective To research the effects of allicin on the apoptosis of human rheumatoid arthritis fibroblast-like synoviocytes (RAFLSs).Methods We collected synovial tissues of patients who suffered rheumatoid arthritis and accepted athroplasty operation or excision of synovial tissues with arthroscopy.The standard of diagnosis of RA was the criteria revised by American College of Rheumatology (ACR).We extracted synoviocytes with trypsin and observed the shape of these cells under optical microscopy.The cluster of differentiation 90 (CD90) of RAFLSs was tested by flow cytometry (FCM).The cells were treated with allicin at different concentrations.The apoptosis rate of RAFLSs was tested through DNA fragmentation assay.Results The positive rate of CD90 in the RAFLSs used to the last research was more than 95％.The apoptosis rate of RAFLSs treated with l00 μmol/L allicin was (6.7 ± 1.1)％.As Compared with the control group,there was no statistically significant difference.The apoptosis rate in 200 and 300 μmol/L allicin-treated groups was (12.9 ± 2.1) ％ and (19.7 ± 1.8) ％ respectively.There was significant difference in the apoptosis rate among the three allicin-treated groups.Conclusion Allicin can accelerate apoptosis of RAFLSs in a concentration dependent manner. Key words: Allicin; Rheumatoid arthritis ; Fibroblast-like synoviocyte; Apoptosis

A multi-center retrospective study of organ involvement in adult patients with polymyositis or dermatomyositis

To explore the prevalence and characteristics of main organ involvement in adult patients with polymyositis (PM) or dermatomyositis (DM) and determine their specific relative factors. Using unified questionnaire, we retrospectively collected the medical records of 1 387 confirmed adult PM/DM patients from 2007 to 2012 at 22 rheumatology centers in China. Statistical analyses were performed with chi-square or Fisher exact test and multivariate analyses with logistic regression. A total of 1 387 patients were collected with 460 (33.2%) PM and 927 (66.8%) DM. The female:male ratio was 2.4: 1. Their onset age was ( 47 ± 14) years. A total of 1 031 (74.3%) patients had organ involvement. The prevalence of pulmonary involvement, arthritis, gastrointestinal and cardiac involvement were 44.6%, 32.3%, 21.9% and 20.3% respectively. The multivariate analysis indicated that older onset age (P < 0.01) was positively associated with pulmonary involvement while myalgia (P < 0.05) was negatively associated. Fever (P < 0.05), weight loss (P < 0.05) and Raynaud's phenomenon (P < 0.01) were positively associated with arthritis while muscle weakness (P < 0.05) negatively associated. Weight loss (P < 0.05), Raynaud's phenomenon (P < 0.01) and muscle weakness (P < 0.05) were positively associated with gastrointestinal involvement. Weight loss (P < 0.05) and swollen limbs (P < 0.05) were positively associated with cardiac involvement. The prevalence of organ involvement is high in adult PM/DM patients. Our study may aid the diagnosis of organ damage in PM/DM patients.

Relationship between mindfulness and time management tendency in nurses of rheumatology department

Objective To explore the relationship between mindfulness and time management tendency in nurses of rheumatology department , so as to provide reference for nurse managers to improve nurses ’ management of time .Methods A total of 353 nurses in rheumatology department from 15 hospitals were chosen by cluster sampling , and mindfulness scale and time management tendency scale were used for investigation . SPSS 16 .0 was used for data analysis .Descriptive analysis was used for mindfulness level and time management tendency and indicated by mean ±177;standard deviation（x-±177;s）, and Pearson as well as linear -regression analysis was used for the relationship between variables .Results A total of 353 questionnaires were handed out and 327 were recovered, with the rate of 92.63%.The score of mindfulness and time management tendency was respectively （3.18 ±177;0.37） and （3.36 ±177;0.51）, and they were positively related （P＜0.05）.To take five dimensions of mindfulness as the independent variable and time management tendency as the dependent variable, three dimensions including mindfulness observation , description and awareness could predict 39.8%amount of variables of time management tendency .Conclusions The mindfulness and time management tendency of nurses in rheumatology department are in the medium level.Mindfulness can effectively predict nurses’ time management tendency, and nurse managers should further train nurses ’ mindfulness to improve their time management tendency. Key words: Nurse; Mindfulness; Time management tendency; Rheumatology department

What is ‘rheumatology’?

What is ‘rheumatology’?

Rheumatology in the 21 st century: Progress, promise and challenges

Rheumatology in the 21 ^st century: Progress, promise and challenges

Rheumatology Around The World … What is New?

Rheumatology Around The World … What is New?

Pain Survey in Rheumatology Outpatient Clinics in Taiwan

Objective: For this study, a pain survey was conducted in the rheumatology outpatient department (OPD) of eight medical centers in Taiwan to determine the prevalence and characteristics of pain in a Taiwanese rheumatology patient population. Methods: Multi-center pain survey was conducted among Taiwanese patients in rheumatology OPDs. Eight medical centers in Taiwan were enrolled from July to September in 2009 to recruit participants. Using a well-designed and validated pain survey questionnaire that was uploaded to touch-screen computers, all questions were answered by the patients themselves and checked by physicians. Results: In all, 8,549 patients were recruited from 8 medical centers in the northern, central and southern regions; 62% (5,316)) of patients had pain, and among them, more than 70% were suffering from moderate to severe pain (VAS ＞4). Chronic pain with duration of more than three months was found in 64% of the with-pain patients. The most common diseases in this pain survey were rheumatoid arthritis (RA, 24.2%), osteoarthritis (OA, 11.2%), systemic lupus erythematosus (SLE, 15.3%), gout (11.9%), ankylosing spondylitis (AS, 8.2%) and other autoimmune diseases (AID, 12.6%). Of the 5,316 patients with pain, females were predominant (64%). The overall average visual analogue scale (VAS) score was 4.76. The prevalence of pain was increased with age. In Taiwan, the highest pain prevalence (68%), but lowest average VAS (4.5), was observed in the central region. In contrast, the highest average VAS (5.33) was found in the southern region. Severe pain was significant in inflammatory and non-inflammatory joint diseases and in fibromyalgia syndrome, compared with SLE or AID. Conclusion: The pain survey revealed that 62% of Taiwanese patients had chronic rheumatic pain and most of them with moderate to severe pain had received pain management. The pain might have resulted from the inadequate or insufficient treatment. The reason for the differences in pain prevalence and severity in different areas of Taiwan remains unknown and further study is needed.

A Retrospective Investigation of Ultrasound Findings in Patients with Shoulder Pain from One Center in Northern Taiwan

Objective: Research has shown that 15-30% of adults experience shoulder pain at some point during the course of their lives. The sensitivity and specificity of musculoskeletal ultrasound (MSUS) have been validated, showing that this tool can complement surgical findings and magnetic resonance imaging. We report ultrasound findings of patients with shoulder pain in rheumatological daily practice. Methods: The subject population for this retrospective study included 240 patients complaining of shoulder pain at the MSUS department of our rheumatology service between January 2010 and December 2012. The ultrasound examination included views of the rotator cuff, the long head of the biceps tendon, the subacromial-subdeltoid bursa, the acromioclavicular joint, and the glenohumeral joint. Results: Of the 240 patients, 140 were women and 100 were men, with ages ranging from 17 to 89 years and a mean age of 54.31 ± 14.64 years. Alterations of shoulder structures were detected in the supraspinatus tendon (76.2%), biceps tendon (62.4%), subscapularis tendon (22.9%), glenohumeral joint (20.4%), acromioclavicular joint (15.3%), subacromial-subdeltoid bursa (13.3%), and infraspinatous tendon (9.2%). Impingement (14.1%) and calcifications (8.2%) were also detected. Eight patients (3.3%) exhibited no sonographic evidence of any alteration. The sensitivity of the technique was confirmed by the finding of alterations in 96.7% of the cases. Conclusion: Although physical examination allows for a diagnostic approach in the treatment of shoulder pain, the technique is typically not accurate enough to ensure that the correct diagnosis is made. MSUS offered the precision necessary to detect the underlying pathology in 97% of the cases.

Analysis of Sources, Purposes and Presentations of Soft-Tissue Masses referred for Ultrasonography

Objective: Soft-tissue masses are common and difficult to accurately diagnosis initially. Therefore, many patients are referred for sonographic study and clinical follow-up. Here, we aimed to analyze the sources, purposes and presentations of those referred. Methods: We analyzed 187 patients referred for evaluation of soft-tissue masses using high-resolution ultrasonography between January 2009 and June 2013. All electronic medical records, reasons for referral, and ultrasonographic reports were reviewed. Results: The study comprised 100 female and 87 male patients aged from 0.25 to 94 years old (mean age, 44.29 years old). Dermatology department referred the majority of the patients, followed by rheumatology. The mean size of lesions was 2.41 cm with a range of 0.30 to 7.70 cm. Lesions (n=187) were usually located on the back (n=36) and lower limbs (n=36). Lipoma was the most commonly diagnosed lesion (n=73), followed by ganglion cyst (n=18) and epidermoid inclusion cyst (n=14). The epidemiology of lesions in this study (age, sex, size, proportion and distribution) resembled with that of a large population study conducted without ultrasonographic intervention. Benefits of ultrasound intervention were also discussed in this study. Conclusion: This study describes the benefit of ultrasonography in soft-tissue masses detection and describes the presentation of soft-tissue masses related in a single medical center in Taiwan.

From past to present: traditional herbs used in the treatment of nephrologic diseases in southeast Turkey.

The use of plants for health care is as old as human history. In cases of disease, the first thing that comes to mind is usually herbs, recommended by older family members who have a knowledge and experience passed down through the generations. According to the World Health Organization (WHO), more than three quarters of the world population trust in herbs as a traditional medicine for health care (1). Unfortunately, most of these plants are consumed as if “harmless.” However, each plant has side effects and toxic properties besides the intended positive effect. A herb may contain hundreds of components having additive or synergistic effects. Root, leaf and flower of the same plant may contain different chemicals. The acidity, mineral content and heavy metal contamination of the plant’s soil would also effect its contents (2). The use of complementary and alternative medicine (CAM) with herbs has been maintaining its popularity since ancient times at an increasing rate, especially in chronic, recurrent and/or incurable diseases. As a Mediterranean country, Turkey has a rich flora and therefore has vast experience of the use of plants for therapeutic purposes. Gaziantep is one of the major cities located on the historical Silk Road in southeast Turkey. It hosted various civilizations, and it inhabitants have a long experience of the use of herbs. In this article, the mostly used traditional plants in the treatment of nephrologic diseases in that region will be discussed. The duties of health professionals to create awareness about the side effects, interactions and toxicities of herbal treatments will be highlighted. The main diseases for CAM in nephrology are hypertension, urolithiasis, recurrent urinary tract infections and enuresis. Department of Pediatric Nephrology and Rheumatology, School of Medicine, Gaziantep University, Gaziantep Turkey Ayse Balat From past to present: traditional herbs used in the treatment of nephrologic diseases in southeast Turkey originAl ArTicle

Editorial: Ethics, Professionalism, and Rheumatology

Editorial: Ethics, Professionalism, and Rheumatology

Patients' Attitudes About Placebo Treatments

In a 2008 survey, more than half of randomly selected U.S. internists and rheumatologists reported they had recommended a placebo treatment (most of the placebos were “active” placebos: e.g., over-the-counter analgesics, vitamins, sedatives, antibiotics) at least once in the past year (NEJM JW Gen Med Oct 30 2008). In contrast, we know little about patients' views of this practice. In this telephone survey of 853 adult members of a large …

Bone, muscle and rheumatology

Bone, muscle and rheumatology

The evaluation of the effectiveness of funding treatment programs in rheumatology

Background: The public payer in Poland has been financing biological drugs in rheumatology since 2004. Until now, there have been no analyses of the influence of this type of funding on the cost level for the public payer. Financing over an 8 year period allows an objective approach towards the results. Materials and methods: Data extracted with the use of data tools reported to the National Health Fund (NFZ) by health service providers, including drugs used in a patient’s therapy. For data analysis, statistic tools were used: Statistica 9 and 10 and Excel spreadsheet. Results: The number of people treated in Poland with biological drugs is approx. 5% of the potential population with rheumatoid joint inflammation diagnosis and juvenile idiopathic joint inflammation. In the analyses, the results of the Kobelt-Kasteng report have been confirmed, referring to the differences existing in Europe when it comes to therapy cost disparity. The cost of therapy in Poland increases depending on the type of therapy: infliximab (for patients up to 70kg), then rituximab and etanercept, adalimumab and infliximab (for patients over 70kg). The calculated price index and therapy cost indicates that the costs of such therapies are lower in Poland in comparison with other countries. The r-Pearson correlation factor of 0.61 to 0.73 indicates that there is an accurate balance between the number of clinics conducting the therapy and the number of patients. In the analyzed period, the budget for the rheumatology biological drug therapy increased.

HCV-related autoimmune disorders in HCV chronic infection.

Patients with hepatitis C virus (HCV) chronic infection may develop a great number of extrahepatic manifestations. Among these latter, mixed cryoglobulinemia (MC) represents the prototype of HCV-associated autoimmune-lymphoproliferative disorders. Other rheumatological manifestations of HCV chronic infection are Siögren syndrome, arthritis and CREST syndrome. Thyroid autoimmune disorders are among the most frequent manifestations of HCV chronic infections and are clinically relevant because of the association with thyroid dysfunctions and hypothyroidism. Autoimmune cytopenia is also reported in association with HCV infection. This paper reviews the association of HCV chronic infection with the above mentioned pathologies, and their immunopathogenesis.

FRI0177 Patient and health professional preferences to route of administration of biologic agents for ra treatment

BackgroundWith the introduction of the biologics, decision-making for rheumatoid arthritis (RA) that affects up to 1% of the population has become even more complex. Assessing patient preferences for treatment in...

SAT0398 Diagnosis of Fibromyalgia is Associated with Impaired Health Outcomes and Substantial Health Care Costs After Nine Months of Follow-Up

BackgroundLittle is known about the impact and prognosis after establishing a diagnosis of fibromyalgia (FM). It is possible that acquiring a ‘FM-label’ may lead to increased illness behaviour, dependence on...